Bianka Saravana-Bawan1, Lindsey M. Warkentin1, Diana Rucker1, Frances Carr1, Thomas A. Churchill1, Rachel G. Khadaroo1. 1. From the Department of Surgery, University of Alberta, Edmonton, Alta. (Saravana-Bawan, Warkentin, Churchill, Khadaroo); the Division of Geriatrics, Department of Medicine, University of Alberta, Edmonton, Alta. (Rucker, Carr); and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alta. (Khadaroo).
Abstract
Background: Among older inpatients, the highest incidence of delirium is within the surgical population. Limited data are available regarding postoperative delirium risk in the acute care surgical population. The purpose of our study was to establish the incidence of and risk factors for delirium in an older acute care surgery population. Methods: Patients aged 65 years or more who had undergone acute care surgery between April 2014 and September 2015 at 2 university-affiliated hospitals in Alberta were followed prospectively and screened for delirium by means of a validated chart review method. Delirium duration was recorded. We used separate multivariable logistic regression models to identify independent predictors for overall delirium and longer episodes of delirium (duration ≥ 48 h). Results: Of the 322 patients included, 73 (22.7%) were identified as having experienced delirium, with 49 (15.2%) experiencing longer episodes of delirium. Postoperative delirium risk factors included Foley catheter use, intestinal surgery, gallbladder surgery, appendix surgery, intensive care unit (ICU) admission and mild to moderate frailty. Risk factors for prolonged postoperative delirium included Foley catheter use and mild to moderate frailty. Surgical approach (open v. laparoscopic) and overall operative time were not found to be significant. Conclusion: In keeping with the literature, our study identified Foley catheter use, frailty and ICU admission as risk factors for delirium in older acute care surgical patients. We also identified an association between delirium risk and the specific surgical procedure performed. Understanding these risk factors can assist in prevention and directed interventions for this high-risk population.
Background: Among older inpatients, the highest incidence of delirium is within the surgical population. Limited data are available regarding postoperative delirium risk in the acute care surgical population. The purpose of our study was to establish the incidence of and risk factors for delirium in an older acute care surgery population. Methods:Patients aged 65 years or more who had undergone acute care surgery between April 2014 and September 2015 at 2 university-affiliated hospitals in Alberta were followed prospectively and screened for delirium by means of a validated chart review method. Delirium duration was recorded. We used separate multivariable logistic regression models to identify independent predictors for overall delirium and longer episodes of delirium (duration ≥ 48 h). Results: Of the 322 patients included, 73 (22.7%) were identified as having experienced delirium, with 49 (15.2%) experiencing longer episodes of delirium. Postoperative delirium risk factors included Foley catheter use, intestinal surgery, gallbladder surgery, appendix surgery, intensive care unit (ICU) admission and mild to moderate frailty. Risk factors for prolonged postoperative delirium included Foley catheter use and mild to moderate frailty. Surgical approach (open v. laparoscopic) and overall operative time were not found to be significant. Conclusion: In keeping with the literature, our study identified Foley catheter use, frailty and ICU admission as risk factors for delirium in older acute care surgical patients. We also identified an association between delirium risk and the specific surgical procedure performed. Understanding these risk factors can assist in prevention and directed interventions for this high-risk population.
Authors: Edward R Marcantonio; Dan K Kiely; Samuel E Simon; E John Orav; Richard N Jones; Katharine M Murphy; Margaret A Bergmann Journal: J Am Geriatr Soc Date: 2005-06 Impact factor: 5.562
Authors: Boukje Koebrugge; Huiberdina L Koek; Remco J A van Wensen; Paul L J Dautzenberg; Koop Bosscha Journal: Dig Surg Date: 2009-01-23 Impact factor: 2.588
Authors: Elizabeth Mahanna-Gabrielli; Kathy Zhang; Frederick E Sieber; Hung Mo Lin; Xiaoyu Liu; Margaret Sewell; Stacie G Deiner; Kenneth S Boockvar Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Rachel G Khadaroo; Lindsey M Warkentin; Adrian S Wagg; Raj S Padwal; Fiona Clement; Xiaoming Wang; William D Buie; Jayna Holroyd-Leduc Journal: JAMA Surg Date: 2020-04-15 Impact factor: 14.766
Authors: Carol J Peden; Geeta Aggarwal; Robert J Aitken; Iain D Anderson; Nicolai Bang Foss; Zara Cooper; Jugdeep K Dhesi; W Brenton French; Michael C Grant; Folke Hammarqvist; Sarah P Hare; Joaquim M Havens; Daniel N Holena; Martin Hübner; Jeniffer S Kim; Nicholas P Lees; Olle Ljungqvist; Dileep N Lobo; Shahin Mohseni; Carlos A Ordoñez; Nial Quiney; Richard D Urman; Elizabeth Wick; Christopher L Wu; Tonia Young-Fadok; Michael Scott Journal: World J Surg Date: 2021-03-06 Impact factor: 3.352
Authors: Chiara Muzzana; Franco Mantovan; Markus Karl Huber; Katia Trevisani; Sarah Niederbacher; Alexander Kugler; Dietmar Ausserhofer Journal: Nurs Open Date: 2022-06-18